Pharmacological Pain Treatment in Older Persons.

Autor: Pickering G; Clinical Pharmacology Department, PIC/CIC Inserm 1405-University Hospital CHU and Faculty of Medicine, Université Clermont Auvergne, Clermont-Ferrand, France. gisele.pickering@uca.fr., Kotlińska-Lemieszek A; Department of Palliative Medicine, Pharmacotherapy in Palliative Care Laboratory, Poznan University of Medical Sciences, Poznań, Poland., Krcevski Skvarc N; Institute for Palliative Medicine and Care, Faculty of Medicine of University Maribor, Maribor, Slovenia., O'Mahony D; Department of Medicine, University College Cork, Cork University Hospital, Cork, Ireland.; Department of Geriatric and Stroke Medicine, Cork University Hospital, Cork, Ireland., Monacelli F; DIMI, University of Genoa, Viale Benedetto XV, Genoa, Italy., Knaggs R; University of Nottingham, University Park, Nottingham, UK.; Pain Centre Versus Arthritis, Clinical Sciences Building, City Hospital, Nottingham, UK.; Primary Integrated Community Services, Nottingham, UK., Morel V; Clinical Pharmacology Department, PIC/CIC Inserm 1405-University Hospital CHU and Faculty of Medicine, Université Clermont Auvergne, Clermont-Ferrand, France., Kocot-Kępska M; Department for Pain Research and Treatment, Medical College Jagiellonian University, Krakow, Poland.
Jazyk: angličtina
Zdroj: Drugs & aging [Drugs Aging] 2024 Dec; Vol. 41 (12), pp. 959-976. Date of Electronic Publication: 2024 Oct 27.
DOI: 10.1007/s40266-024-01151-8
Abstrakt: Pharmacological pain treatment in older persons is presented by a multi-disciplinary group of European pain experts. Drugs recommended for acute or chronic nociceptive pain, also for neuropathic pain and the routes of administration of choice are the same as those prescribed for younger persons but comorbidities and polypharmacy in older persons increase the risk of adverse effects and drug interactions. Not all drugs are available or authorised in all European countries. For mild-to-moderate pain, non-opioids including paracetamol and non-steroidal anti-inflammatory drugs are first-line treatments, followed by nefopam and metamizole. Codeine, dihydrocodeine and tramadol are prescribed for moderate to severe pain and 'strong' opioids, including morphine, hydromorphone, oxycodone, fentanyl, buprenorphine, methadone and tapentadol, for severe pain. Chronic neuropathic pain treatment relies on coanalgesics, including anti-epileptics (gabapentinoids) and anti-depressants with additional option of topical lidocaine and capsaicine. The choice of analgesic(s) and the route of administration should be guided by the pain characteristics, as well as by the patient's comorbidities, organ function and medications. Several directions have been highlighted to optimise pharmacological pain management in older individuals: (1) before starting pain treatment adequately detect and assess pain and always perform a full geriatric assessment, (2) consider kidney function systematically to adjust the doses of analgesics and avoid the risks of overdose, (3) start with the lowest dose of an analgesic and increase it gradually under the control of the effect, (4) involve the older persons and family in their treatment, (5) reevaluate pain regularly during treatment and (6) combine pharmacological treatment with non-pharmacological approaches.
Competing Interests: Declarations. Conflicts of interest: Pickering Gisèle (GP), Kotlińska-Lemieszek Aleksandra (AK), Krcevski Skvarc Nevenka (NK), O’Mahony Denis (DO), Monacelli Fiammetta (FM), Knaggs Roger (RK), Morel Véronique (VM), Kocot-Kępska Magdalena (MK) have no conflicts of interest related to this article. Author contributions: GP, AK, NK, DO, FM,RK, VM, MK all contributed equally to the manuscript. Funding: No funding to report for the preparation of the paper. Ethics approval: Not applicable. Consent (participation and publication): Not applicable. Data availability statement: Data sharing not applicable to this article as no datasets were generated or analysed during the current study. Code availability: Not applicable.
(© 2024. The Author(s).)
Databáze: MEDLINE
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